Discussion Forums > Diet, Nutrition and Supplements
Multivitamins for thal major children
Andy Battaglia:
What Sharmin has said is correct. Vitamin C should be taken between meals, so that it doesn't cause added iron to be absorbed from foods. (However, the effect of C in this process is now in question and apparently, vitamin C does not necessarily cause excess C absorption, but to be safe for now, do take it between meals). It has been believed that citrus fruits should be taken between meals as to minimize iron absorption.
Of course, this all flies in the face of reality because vitamin C is the single most important vitamin and we know that thalassemics are almost universally deficient in vitamin C. High doses when used with desferal are thought to be unsafe because of the possibility of high amounts of iron being released into the blood where they can gather in the heart causing some reduction in heart function. The doses cited were 800 mg or more, so we always recommend taking no more than 250 mg daily for thalassemics.
Now, for some research that blows up the theory that C should be avoided because it raises ferritin.
http://www.mayoclinicproceedings.com/inside.asp?AID=4676&UID=
--- Quote ---Higher fresh fruit intake, excluding citrus fruits and citrus juices, was associated with significantly reduced serum ferritin levels in men for both age-adjusted and multivariate-adjusted values (P=.002, Table 3). Adjusted mean ferritin levels were reduced with consumption of 7 or more pieces of fruit per week, with the lowest mean and adjusted mean ferritin levels seen with consumption of 14 or more pieces of fruit per week (Table 3) (ie, 2 or more pieces of fruit daily on average). This level of consumption was associated with a reduction of approximately 20% below the mean value of approximately 180 μg/L (to convert to pmol/L, multiply by 2.247) of ferritin seen in the groups consuming 0 to 6 pieces of fruit per week (ie, <1 piece of fruit daily on average). No significant effects of any kind (P>.1) were observed for fresh fruit consumption in women (Table 3). Consumption of citrus fruits and citrus juices (specifically orange and grapefruit) did not confer protective effects, with no significant effects on serum ferritin levels in either sex (Table 3). Consumption of vitamin C alone or as part of a multivitamin supplement did not affect serum ferritin levels in either sex (P>.1, data not shown).
--- End quote ---
Non-citrus fruits actually lowered serum ferritin in subjects. Citrus did not lower ferritin, but it also had no effect on raising ferritin. This is alarming news in light of the warnings against eating citrus or taking vitamin C supplements.
I have always realized that there was a major paradox when it comes to vitamin C and thalassemics. Thals are almost always deficient but have been warned against taking C. My intuition has always told me that this thinking cannot be correct. This study basically blows apart previous thinking about vitamin C. While thals should avoid large doses, they should NOT avoid vitamin C altogether. You read it here first. Whether you are using desferal or not, please take vitamin C supplements or eat some citrus daily. Your (bruised) body will thank you. The other part of this study shows that non-citrus fruits actually lowered serum ferritin so eat up!
This is huge. I would be very interested in what Dr Vichinsky has to say about these findings.
Manal:
Andy, that is amazing... but on what basis we had our old idea that citric fruit increases the ferritin level?????????? It should be studies too or what??? Is vitamin C still help in iron absorption????
Maybe vitamin C increases serum iron which is used by the body and thus does not stored as ferritn and therefore ferritin desn't increase??? Totally confused :huh :huh :huh :huh
manal
Sharmin:
Andy,
If citrus does not increase SF levels then the reasoning behind pairing it with desferal chelation also changes. If vitamin C does not release iron stores from the liver then it does not make more iron available in the plasma for desferal to remove. Nonetheless, vitamin C is important for the body so it is best to take it.
Sharmin
Andy Battaglia:
I don't think you can conclude that vitamin C doesn't release iron from the liver because we are talking about serum ferritin and not free iron. This is a very important distinction. What this shows is that vitamin C is not increasing serum ferritin as relates to diet. I think that it still holds that C does release more free iron from cells and is why we still need to stick to relatively low doses of C for thal majors. However, thal majors should not have to watch their diet to avoid C foods and a small (250 mg) dose daily should be perfectly safe. Just this amount would correct many problems, so thals who are trying to avoid C altogether can rest assured that they can eat citrus and take a supplement daily. For thals who bruise easily, please pay attention to this. Vitamin C can do a lot to prevent bruising. but even this is not the most important thing. Part of the long term problem with thalassemia in addition to iron overload, is the reduction of function of blood vessels. This is reflected in easy bruising. Vitamin C is essential for normal health of the circulatory system. I would add vitamin E, magnesium, maybe vitamin D, and nitirc oxide inducers such as L-carnitine and to this mix. Preventing a reduction in efficiency of blood vessels is extremely important. as this is the main cause of heart failure in thals after iron overload, and I suspect, these nutrients will do much to prevent the pulmonary hypertension that is so common in older thals and especially thal intermedia (60% rate of PHT).
I do believe that everyone can benefit from certain supplements but with thals, they become a matter of health and should not be considered optional.
Sharmin:
Andy,
Thanks, that post fills in a lot of gaps in my understanding. I so wish that L-carnitine was available in Canada :wah.
Sharmin
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